Elbow > Treatments
Preparing for Surgery
The decisions you make and the actions you take before
your surgery can be every bit as important as the procedure
itself in ensuring a healthy recovery.
a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
your outpatient (ambulatory) surgery. After you have
checked in to the hospital or clinic, you will go to
a holding area where the final preparations are made.
The paperwork is completed and your elbow may be shaved,
though this is not always necessary. You will wear a
hospital gown and remove all of your jewelry. You will
meet the anesthesiologist or anesthetist (a nurse who
has done graduate training to provide anesthesia under
the supervision of an anesthesiologist). Then, you will
walk or ride on a stretcher to the operating room. Most
patients are not sedated until they go into the operating
room. Here are some important things to remember for
the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose, oversized shirt that will fit comfortably over
an elbow bandage when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Debridement surgery usually takes
about 30 to 45 minutes to perform. Unhealthy tissue
is removed from the tendon connecting your forearm muscles
to the outside of your elbow. This also stimulates blood
flow to the tendon, which helps it to heal properly.
will either be put under general anesthesia or have
your arm numbed with a regional anesthesia that is injected
into your shoulder.
make a one- to three-inch incision in the skin over
the bump on the outside of the elbow. (Some surgeons
have begun performing debridement surgery arthroscopically,
but this technique has not yet come into widespread
incision exposes the damaged tendon that is usually
visibly degenerated, discolored, or torn.
surgeon removes (debrides) the damaged portion. Sometimes
the surgeon also removes part of the bony bump on the
side of the elbow (lateral epicondyle) and may need
to reattach surrounding tendon to the bone.
remaining healthy tendon tissue is sewn together.
are stitched with either absorbable or nonabsorbable
sutures and you are taken to the recovery room.
When you awaken in the recovery room following surgery,
your elbow is usually wrapped in gauze, bandaged, and
covered with an ice pack. Some surgeons place your arm
in a posterior splint for seven to 14 days after surgery.
This is a sheet of plaster wrapped in cotton and positioned
along the back of your arm that keeps your elbow bent
at 90 degrees. You usually stay in the recovery room
for at least two hours while the anesthetic wears off.
General anesthesia wears off in about an hour and regional
anesthesia may take about two hours to wear off. You
will be given adequate pain medicine, either orally
or through an IV (intravenous) line, as well as instructions
for what to do over the next couple of days. In addition,
you will be given an appointment to return and a prescription
for pain medicine. You may initially have significant
pain in the elbow and moving your wrist also may cause
pain. You should take the pain medicine as directed.
Remember that it is easier to keep pain suppressed than
it is to treat pain once it becomes present. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse, who, with the assistance of the doctor, will
determine when you are ready to leave the hospital.
The majority of patients leave the hospital after two
or three hours. As soon as you are fully awakened, you
are usually allowed to go home. You will be unable to
drive a car, so be sure to have arranged a ride home.
Depending on much you rely on the injured hand, you
may be able to wuickly return to work after debridement
surgery. Doctors strongly recommend that you avoid any
movement that strains your wrist. In general, you want
to avoid movements and activities that cause the forearm
muscles to flex repeatedly. Physicians generally recommend
that you avoid picking up heavy objects until all the
pain has gone away. You should usually avoid lifting
objects that weigh over five pounds for four to six
weeks. After surgery, you should learn to pick things
up with your palm facing up, instead of down, to relieve
stress on the wrist extensor muscles in your forearm.
Here is what you can expect and how you can cope after
will likely feel pain or discomfort for the first few
days, and you will be given pain medications as needed.
Many patients may be given a narcotic painkiller.
may be some minor drainage on the bandage since fluid
may have accumulated during the surgery. Some blood
may show through the bandage during the first 24 hours.
much as possible, you should keep your elbow elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows under your arm. Icing your
elbow for 20 or 30 minutes a few times a day during
the first two days after surgery also will reduce pain.
Your doctor and physical therapist will most likely
prescribe several exercises to stretch the arm muscles
and build strength around the elbow. This helps relieve
stress to the extensor tendon that attaches the forearm
muscle to the bony bump on the outside of the elbow.
Most people do not begin exercises until swelling and
pain has been reduced. Your physician and physical therapist
will decide on a custom rehab program that varies depending
on your body type, level of involvement in activities,
and severity of tennis elbow. It may take three to six
months to return to activities. In general, rehabilitation
of the elbow can be broken into four phases:
motion Gentle stretching with the aid of a physical
therapist can help reestablish a pain-free range of
motion, reduce pain and inflammation, and prevent your
muscles from weakening due to inactivity.
exercise The goals are to increase elbow mobility,
improve strength and endurance, and enhance your muscular
control around the elbow with light exercises. You should
have full range of motion and feel little pain in your
elbow before advancing to this stage of rehab.
strengthening Once you have returned to about
70 percent of your own healthy arm strength, you can
begin exercises to build total arm strength. If you
remain pain-free, you can start to test your power and
endurance with more complicated exercises. The goal
is to increase your coordination to prepare you for
to activities Your physical therapist can make
sure you have a full and pain free range of motion before
your rehab is finished. Progressive functional drills,
which teach you proper technique, are usually the final
phase of rehab.
Rehabilitating tennis elbow can be difficult because
so many daily activities, like turning doorknobs, can
cause pain during the first few weeks. Try to be patient
and follow your physical therapists instructions.
Using proper form during activities, whether they are
sports- or work-related, can help prevent the recurrence
of tennis elbow. Your physical therapist can teach you
proper posture and technique that can lessen the strain
on your elbow's tendons. An important prevention technique
is to learn to lift objects with your palm facing up.
The everyday strain of lifting objects with the palm
down puts extra stress on your outside forearm muscles.
Be sure to gradually increase the intensity of manual
activities. For example, avoid playing several hours
of tennis if you have not played for months, or taking
on a big carpentry project when you have not picked
up your tools for a while. With a chronic overuse injury
like tennis elbow, you may strain your tendon one day
but not feel significant pain until a few days later.
To prevent reinjury, it is important to know your limits
beforehand and be cautious when repeatedly using your
wrist during activities. When you have to use your wrist
and elbow, try to ice the outside of your elbow after
activities. Physicians generally recommend that you
use tools and sports equipment that is properly sized
to fit your hand. If your doctor prescribed a brace,
be sure to wear it during activities. In general, you
should make the stretching and strengthening you learned
in rehab part of your regular exercise routine.
Surgery to treat tennis elbow is rare. However, if you
have been unable to heal tennis elbow after about a
year of non-surgical treatment, including a supervised
rehabilitation program, you may be a candidate for surgery.
Most patients feel a dramatic improvement in tennis
elbow symptoms after a debridement procedure, but often
have a slight residual weakness in the muscles that
bend the wrist backward. Debridement basically removes
damaged tissue from the tendon that connects your forearm
muscles to the bony bump (lateral epicondyle) on the
outside of your elbow. It stimulates blood flow to the
tendon, which can help healthy tissue replace degenerated
or torn tissue.